Arthritis Flashcards
Define osteoarthritis
Slowly progressive degeneration of articular cartilage
RF osteoarthritis (4)
Obesity
Occupation
Age
Female gender
What can cause secondary osteoarthritis
Inflammatory arthritis
Metabolic conditions
Trauma
Deformity
What deformity can cause secondary osteoarthritis
developmental dysplasia of the hip
What metabolic conditions can cause secondary osteoarthritis
haemochromatosis, Wilson’s disease
Presentation of osteoarthritis (4)
Pain worse at end of day
Asymmetrical joint stiffness, especially after inactivity
Joint crepitus
Restricted activity
Which joints are most commonly affected by OA (6)
Weight bearing joints (hip, knee) Heavy use (DIP, PIP, 1st CMC, wrist)
What is seen on the hands of OA patients and which one is which (2)
Heberdens node DIPJ
Bouchards node PIPJ
What is seen in the X ray of osteoarthritis (4)
Loss of joint space
Osteophytes
Subchondral sclerosis
Subchondral cysts
What is seen in the joint aspirate of osteoarthritis (4)
Straw coloured fluid
Increased viscosity
RA definition
Chronic (>6 weeks), systemic inflammatory disease characterised by symmetrical deforming polyarthritis (>4 joints)
and extra-articular manifestations
How many joints are affected rheumatic arthritis
> 4
RF RA (2)
HLA DR4 mutation
Smoking
What is the gender ratio of RA
1:2
Male to female
What is the standard AI gender ratio
1 : 2 (autoimmune)
Male : female
History of RA
Pain worse at start of day
Joint stiffness for >1h in morning
Restricted activity
Which joints are affected in RA (6)
Small joints of hands (PIP, MCP, wrist – NOT DIP)
Other joints: hip, knee, shoulders
What later deformities are seen in RA (5)
Wrist: radial deviation
MCP: ulnar deviation of fingers, Z-deformity of thumb
PIP/DIP: Boutoinniere deformity, Swann neck deformity
Extra-articular manifestations of RA (7)
Rheumatoid nodules Lymphadenopathy Eyes: episcleritis Lungs/hearts: pleuritis (fibrosis) /pericarditis Amyloidosis Haematological: Anaemia of chronic disease Felty syndrome
What does synovial inflammation lead to in RA
Tenosynovitis
Bursitis
What haematological complications of RA can you get (2)
Anaemia of chronic disease
Felty syndrome
What is the Felty syndrome triad
Splenomegaly
Neutropenia
Anaemia of chronic disease
Systemic symptoms of RA (3)
Fever
Wt loss
Fatigue
What is seen in the X-ray of RA
Uniform joint space narrowing
Juxta-articular osteopenia
Joint erosions at joint margins
Joint deformity & destruction
What do you test for in the blood of RA (6)
Chronic inflammation: Anaemia of chronic disease ↑ ESR/CRP Low albumin Antibodies: Rheumatoid factor (IgM against IgG) Anti-CCP (most specific)
Which antibodies in RA
Rheumatoid factor (IgM against IgG) Anti-CCP (most specific)
What is primary amyloidosis associated with (3)
multiple myeloma, lymphoma, waldenstron’s macroglobulinaemia
What is secondary amyloidosis associated with (4)
with RA, IBD/UC, chronic infections (e.g TB)
What is the difference between primary and secondary amyloidosis
Primary amyloidosis (AL amyloidosis) Deposition of immunoglobin light chain
Secondary amyloidosis (AA amyloid) Deposition of serum amyloid A (acute phase protein)
Presentation of amyloidosis (6)
Nephrotic syndrome Hepatosplenomegaly Carpal tunnel syndrome + peripheral neuropathy Periorbital purpura Restrictive cardiomyopathy (1o) Macroglossia (1o)
Which presentation of amyloidosis is solely in primary amyloidosis (2)
Restrictive cardiomyopathy (1o) Macroglossia (1o)
Diagnostic test of amyloidosis
Apple-green birefringence under polarised light with Congo Red stain
What are the Seronegative spondyloarthropathies (4)
PEAR
Psoriatic arthritis
Enteropathic arthritis
Ankylosing spondylitis
Reactive arthritis
Associations/presentation of the seronegative arthropathies (5)
HEADS
HLA B27 Enthesitis Asymmetrical oligoarthritis with Axial involvement and extra-articular involvement Dactylitis Seronegative